How I do it: flexible endoscopic aspiration of intraventricular hemorrhage
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HOW I DO IT - VASCULAR NEUROSURGERY - OTHER
How I do it: flexible endoscopic aspiration of intraventricular hemorrhage Alberto Feletti 1
&
Luca Basaldella 2 & Alessandro Fiorindi 3
Received: 29 April 2020 / Accepted: 14 July 2020 # The Author(s) 2020
Abstract Background As intraventricular blood is a strong negative prognostic factor, intraventricular hemorrhage requires prompt and aggressive management to reduce intracranial hypertension. Method A flexible scope can be used to navigate and to aspirate blood clots from all four ventricles. Complete restoration of CSF pathways from the lateral ventricle to the foramen of Magendie can be obtained. Conclusion Flexible neuroendoscopic aspiration of IVH offers the opportunity to immediately reduce intracranial hypertension, reduce EVD obstruction and replacement rates, and decrease infections and shunt dependency. Keywords IVH . Hemorrhage . Endoscopy . Flexible . Brain ventricles . EVD . Aneurysm
Relevant surgical anatomy During the endoscopic aspiration of intraventricular hemorrhage (IVH), the vision of anatomical landmarks is severely impaired. A detailed knowledge of intraventricular anatomy is therefore mandatory before facing this type of surgery [2, 5, 7, 8].
Description of the technique A precoronal, paramedian 3-cm-long, curved skin incision is performed at the side of the lateral ventricle with the largest This article is part of the Topical Collection on Vascular Neurosurgery Other Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04499-z) contains supplementary material, which is available to authorized users. * Alberto Feletti [email protected] 1
Department of Neurosciences, Biomedicine and Movement Sciences, Institute of Neurosurgery, University of Verona, AOUI Verona, Polo Chirurgico “P. Confortini”, P.le Stefani 1, 37126 Verona, Italy
2
Unit of Neurosurgery, Treviso Regional Hospital, Treviso, Italy
3
Unit of Neurosurgery, Spedali Civili, University of Brescia, Brescia, Italy
amount of blood. The burr hole must be placed not too laterally, at about 1.5 cm from the midline (Fig. 1). This is crucial in order to have a more straight direction of the scope towards the cerebral aqueduct and to be able to smoothly enter the fourth ventricle later on during the procedure. Lateral ventricle is cannulated with a semirigid 14-French peel-away introducer catheter, through which the flexible endoscope is inserted (Fig. 1). Different types of flexible scopes are available in the market with external diameter ranging from 2.8 to 5 mm. However, external diameter should not be larger than 4 mm for this kind of procedure (Fig. 1). Such size can fit the diameter of the cerebral aqueduct allowing its safe navigation. The diameter of the operative channel ranges from 1.2 to 1.5 mm. When the lateral ventricle is explored, the screen appears completely red or dark because the tip of the scope is dipped in blood. Although the severely impaired vision might be worrisome and frustrating, intermittent asp
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